National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (2)
- Alcohol Use (1)
- Cardiovascular Conditions (1)
- Care Management (1)
- Children/Adolescents (3)
- Diagnostic Safety and Quality (2)
- Disparities (1)
- Education: Continuing Medical Education (2)
- Emergency Department (9)
- (-) Emergency Medical Services (EMS) (18)
- Evidence-Based Practice (2)
- Guidelines (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (3)
- Hospitals (2)
- Imaging (1)
- Medicare (1)
- Mortality (1)
- Nursing (2)
- Outcomes (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Payment (1)
- Policy (1)
- Provider (1)
- Provider Performance (1)
- Research Methodologies (1)
- Sepsis (1)
- Shared Decision Making (2)
- Stroke (3)
- Surgery (1)
- Trauma (2)
- Uninsured (1)
- Vulnerable Populations (1)
- Workflow (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedRhee C, Kalil AC
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
In this paper the authors discuss an article by Lane et al., published in 2018 in JAMA Network Open, related to the early administration of intravenous fluids in patients with sepsis.
AHRQ-funded; HS025008.
Citation: Rhee C, Kalil AC .
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
JAMA Netw Open 2018 Dec 7;1(8):e185844. doi: 10.1001/jamanetworkopen.2018.5844..
Keywords: Emergency Medical Services (EMS), Mortality, Sepsis
Adelgais KM, Hansen M, Lerner EB
Establishing the key outcomes for pediatric emergency medical services research.
The evidence supporting best practices when treating children in the prehospital setting or even the effect emergency medical services (EMS) has on patient outcomes is limited. This article describes a consensus process among stakeholders in the pediatric emergency medicine and EMS community that identified the critical outcomes for EMS care in five clinical areas (traumatic brain injury, general injury, respiratory disease/failure, sepsis, and seizures).
AHRQ-funded; HS026101.
Citation: Adelgais KM, Hansen M, Lerner EB .
Establishing the key outcomes for pediatric emergency medical services research.
Acad Emerg Med 2018 Dec;25(12):1345-54. doi: 10.1111/acem.13637..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Evidence-Based Practice, Health Services Research (HSR), Outcomes, Patient-Centered Outcomes Research
Ali A, Zachrison KS, Eschenfeldt PC
Optimization of prehospital triage of patients with suspected ischemic stroke.
Prehospital routing algorithms for patients with suspected stroke because of large vessel occlusions should account for likelihood of benefit from endovascular therapy (EVT), risk of alteplase delays, and transport times. In this study, the investigators present a mathematical decision model that determines ideal prehospital routing recommendations for patients with suspected stroke because of large vessel occlusions, with consideration of patient characteristics and location at onset.
AHRQ-funded; HS024561.
Citation: Ali A, Zachrison KS, Eschenfeldt PC .
Optimization of prehospital triage of patients with suspected ischemic stroke.
Stroke 2018 Oct;49(10):2532-35. doi: 10.1161/strokeaha.118.022041..
Keywords: Emergency Medical Services (EMS), Stroke
Gyftopoulos S, Smith SW, Simon E
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
The purpose of the study was to better understand, using semi-structured interviews, the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. The authors found that EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Smith SW, Simon E .
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
J Am Coll Radiol 2018 Sep;15(9):1276-84. doi: 10.1016/j.jacr.2017.08.022..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Imaging
Fong A, Kim TC, Ratwani RM
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
This paper presents Task2Heart, a system developed to integrate near real-time heart rate with in-situ time motion observations. The authors describe and validate the system and discuss its use in the exploration of emergency physician heart rate in-situ.
AHRQ-funded; HS024801.
Citation: Fong A, Kim TC, Ratwani RM .
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
J Med Syst 2018 Aug 7;42(9):170. doi: 10.1007/s10916-018-1024-4..
Keywords: Cardiovascular Conditions, Emergency Department, Workflow, Emergency Medical Services (EMS)
Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
The objective of the study was to compare in-hospital emergency medicine (EM) trainees' performance on endotracheal intubation (ETI) delivered from both the seated and standing positions. The study concluded that the position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, the findings suggest that there may be value in training residents to perform ETI from both positions.
AHRQ-funded; HS021456.
Citation: Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM .
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
West J Emerg Med 2018 Jul;19(4):660-67. doi: 10.5811/westjem.2018.4.37227..
Keywords: Education: Continuing Medical Education, Emergency Medical Services (EMS), Patient Safety, Provider Performance
Joseph D, Vogel JA, Smith CS
Alcohol as a factor in 911 calls in Denver.
This study analyzed data from 911 calls in Denver, Colorado to determine the impact of excessive alcohol consumption on those calls. The number of calls made from July 1, 2012 to June 30, 2014 was 169,642 and of those calls 30% had alcohol consumption has a main factor, and 29% as a contribution factor. These calls were more likely associated with male sex, traumatic injuries, advanced monitoring, airway adjuncts, and medications for sedation.
AHRQ-funded; HS023901.
Citation: Joseph D, Vogel JA, Smith CS .
Alcohol as a factor in 911 calls in Denver.
Prehosp Emerg Care 2018 Jul-Aug;22(4):427-35. doi: 10.1080/10903127.2017.1413467..
Keywords: Alcohol Use, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
AHRQ-funded; HS023641.
Citation: Mistry B, Stewart De Ramirez S, Kelen G .
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
.
.
Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT), Nursing
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Mbachu SN, Pieribone VA, Bechtel KA
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
The authors conducted a pilot study to optimize screening, recruitment, and enrollment strategies for a larger, fully-powered study that seeks to identify proteins in the blood of adolescent athletes following a concussion that are significantly and consistently altered compared with age- and gender-matched controls with isolated extremity injuries. They found that EHR-based notifications and financial incentives for participation in ED research on prolonged recovery in adolescents with concussion increased participant identification and enrollment and retention rates to inform and optimize the enrollment and recruitment strategies for a larger study. There was a clear trend for participants to present to the ED on nights or weekends, likely reflecting the time of sport play.
AHRQ-funded; HS021271.
Citation: Mbachu SN, Pieribone VA, Bechtel KA .
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
Am J Emerg Med 2018 May;36(5):884-87. doi: 10.1016/j.ajem.2017.09.014.
.
.
Keywords: Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Research Methodologies
Velopulos CG, Shihab HM, Lottenberg L
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
This study reviewed the published evidence on prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma in order to structure a practice management guideline. Using a Cochrane-style systematic review, 24 studies met inclusion criteria; five studies were used for the quantitative review. No study showed benefit to spine immobilization with regard to mortality and neurologic injury, even for patients with direct neck injuries. Increased mortality was associated with spine immobilization. The authors recommend that spine immobilization not be routinely used for adult patients with penetrating trauma.
AHRQ-funded; HS024547.
Citation: Velopulos CG, Shihab HM, Lottenberg L .
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
J Trauma Acute Care Surg 2018 May;84(5):736-44. doi: 10.1097/ta.0000000000001764..
Keywords: Care Management, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines, Trauma
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
.
.
Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Newgard CD, Uribe-Leitz T, Haider AH
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
This paper is a commentary on an article by Voskens FJ, et al., published in 2017 in JAMA Surgery, entitled “Accuracy of prehospital triage in selecting severely injured trauma patients.”
AHRQ-funded; HS023796.
Citation: Newgard CD, Uribe-Leitz T, Haider AH .
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
AHRQ-funded; HS023796..
Keywords: Emergency Medical Services (EMS), Health Services Research (HSR), Trauma
Ray KN, Olson LM, Edgerton EA
Access to high pediatric-readiness emergency care in the United States.
The researchers determined the geographic accessibility of emergency departments (EDs) with high pediatric readiness by assessing the percentage of US children living within a 30-minute drive time of an ED with high pediatric readiness, as defined by collaboratively developed published guidelines. They concluded that a significant proportion of US children do not have timely access to EDs with high pediatric readiness.
AHRQ-funded; HS022989.
Citation: Ray KN, Olson LM, Edgerton EA .
Access to high pediatric-readiness emergency care in the United States.
J Pediatr 2018 Mar;194:225-32.e1. doi: 10.1016/j.jpeds.2017.10.074.
.
.
Keywords: Access to Care, Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Children/Adolescents
Schoenfeld EM, Goff SL, Elia TR
A qualitative analysis of attending physicians' use of shared decision-making: implications for resident education.
This study explored emergency medicine (EM) attending physicians' use of shared decision-making (SDM) in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. The investigators concluded that a constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
AHRQ-funded; HS024311.
Citation: Schoenfeld EM, Goff SL, Elia TR .
A qualitative analysis of attending physicians' use of shared decision-making: implications for resident education.
J Grad Med Educ 2018 Feb;10(1):43-50. doi: 10.4300/jgme-d-17-00318.1..
Keywords: Shared Decision Making, Education: Continuing Medical Education, Emergency Medical Services (EMS), Provider
Khubchandani JA, Shen C, Ayturk D
Disparities in access to emergency general surgery care in the United States.
This study examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. The study concluded that gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities and policy initiatives need to increase emergency general surgery capacity nationwide.
AHRQ-funded; HS022694.
Citation: Khubchandani JA, Shen C, Ayturk D .
Disparities in access to emergency general surgery care in the United States.
Surgery 2018 Feb;163(2):243-50. doi: 10.1016/j.surg.2017.07.026..
Keywords: Access to Care, Disparities, Emergency Medical Services (EMS), Surgery, Vulnerable Populations
Hinson JS, Martinez DA, Schmitz PSK
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
This study sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. It concluded that, despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints were particularly under-appreciated.
AHRQ-funded; HS023641.
Citation: Hinson JS, Martinez DA, Schmitz PSK .
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
Int J Emerg Med 2018 Jan 15;11(1):3. doi: 10.1186/s12245-017-0161-8.
.
.
Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Delivery, Nursing
Hsuan C, Horwitz JR, Ponce NA
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
EMTALA, which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. Respondents identified 5 main causes of noncompliance as well as suggesting methods to improve compliance.
AHRQ-funded; HS024247.
Citation: Hsuan C, Horwitz JR, Ponce NA .
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
J Healthc Risk Manag 2018 Jan;37(3):31-41. doi: 10.1002/jhrm.21288.
.
.
Keywords: Emergency Medical Services (EMS), Payment, Hospitals, Medicare, Uninsured